Coulrophobia: An investigation of clinical features

Background: Coulrophobia refers to fear or disgust elicited by clowns, or images of clowns, and may be accompanied by significant distress. The medical literature on sociodemographic and clinical features of coulrophobia is, however, sparse. Aim: This study aimed to investigate coulrophobia sociodemographic and clinical features in an online support group. Setting: A self-administered questionnaire was distributed to an online support group for coulrophobia. Methods: Members of the online coulrophobia support group received a link to a selfadministered questionnaire. The questionnaire focused on sociodemographic and clinical features, including fear-related and disgust-related symptoms, and included DSM-5 diagnostic criteria for specific phobia. Results: Of the 95 survey respondents, 79 were female respondents (mean age: 39.8 ± 12.6 years), with the mean age of onset 9 ± 6.1 years. Coulrophobia symptoms were associated with significant psychological distress and with impaired social functioning. About 7.4% of respondents reported severe anxiety with panic attacks. Comorbid disorders included major depressive disorder (9.5%), obsessive-compulsive disorder (5.3%) and panic disorder (3.2%). Individuals with fear-related symptoms were more likely to fulfil DSM-5 criteria for specific phobia. Conclusion: Coulrophobia is a phenomenon that warrants clinical attention, given its association with significant comorbidity, psychological distress and impaired functioning. Several sociodemographic and clinical features are consistent with a diagnosis of specific phobia, although future work employing clinician-administered diagnostic tools is needed to consolidate and extend the findings here.